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Page 1: Kubler ross stages of dying -grief

www.drjayeshpatidar.blogspot.com

Kubler-Ross Stages of Dying / Grief

Precipitating Factors of Grief

Death in family

Separation

Divorce

Physical Illness

Work failure disappointments

1. Denial

Initial response to protect the self from anxiety.

“No not me”, “Its not true”, “Its not impossible”

May continue to make impractical/unrealistic plans

May comment that a mistake has been made about

the diagnosis of terminal illness

May appear normal and can continued ADL as if

nothing is wrong

May not conform with the advised treatment

regimen

Adaptive response – crying, verbal denial

Maladptive response – absence or reaction such as

crying.

2. Anger

Individual feel that they are victims of incompetence or a vengeful God (they did

something wrong so they are being punished), fate (karma), circumstances (wrong place

and wrong time).

“Why me”, “What did I do to deserve this?”

They seek for reasons, answers and explanations

May express anger overtly – being irritable, impatient, critical verbally abusive.

May express anger covertly by neglecting self, not eating, nor going to check ups,

committing suicide, drinking alcohol.

Adaptive response – verbal expression

Maladaptive – persistent guilt or low self esteem, aggression, self destructive ideation or

behavior.

3. Bargaining

Page 2: Kubler ross stages of dying -grief

www.drjayeshpatidar.blogspot.com

The person try to inhibit good behavior, make up for perceived wrong doings or other

engage in behaviors that would please GOD so he will be given more time-an extension

of life or granted recovery.

“Yes, me but”

“If I live until Christmas or until my child’s graduation ( So many if’s), I will do this…”

Adaptive response – bargains for treatment control, express wish to be alive for specific

events in the near future.

Maladaptive response – bargains for unrealistic activities or events in the distant future.

4. Depression

Occurs when the reality of loss or impending loss cannot be ignored anymore and the

person grieves for himself and those he will leave behind, for the things that he can no

longer accomplish or experience.

“Yes, I’m dying”

Withdrawn, has no energy and interest to interact.

Cries

Makes few demands

Adaptive response – crying, withdrawing from interaction

Maladaptive response – self destructive actions, despair.

5. Acceptance

Occurs when the person has come to peace with himself and others

“Yes, I am ready”

Stage of affective void – not happy nor sad

Only persons who are highly significant to him stimulates a reaction. Others are merely

tolerated.

Makes realistic preparation

Adaptive response – may wish to be alone, limit conversation, complete personal and

family business.

Nursing Interventions:

Assess; specific loss, meaning of loss, coping skills, support persons.

Accept the client; do not respond personally to the client.

Support adaptive responses; allow to express feelings

Support defense mechanism – reassure client that denial and wanting to be alone is

normal.

Help find constructive outlets of anger. Do not take clients hostility personally. Do no

retaliate.

Monitor for self destructive behaviors

Help express feelings: Ask how they feel

Meet needs

Allow as much decision making as possible to maintain dignity by giving choices and

alternatives.

Page 3: Kubler ross stages of dying -grief

www.drjayeshpatidar.blogspot.com


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